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Darla Shine’s Measles Misinformation

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Over a nearly 18-hour Twitter spree, Darla Shine, the wife of Bill Shine, President Donald Trump’s deputy chief of staff for communications, made a series of false and misleading statements about measles and vaccines.

  • Shine said to “bring back” childhood diseases because “they keep you healthy & fight cancer.” Childhood diseases, of course, make people sick — not healthy — and they can be deadly; they also don’t protect against cancer. While survivors gain immunity, the same effect can be achieved far more safely with vaccines.
  • She cited news stories about a clinical trial at the Mayo Clinic to support her claim that measles can “fight cancer.” But the researchers weren’t giving patients the measles to kill cancer cells; they were giving them a weakened version of the measles virus that’s similar to the vaccine.
  • Shine suggested that her children would not have lifelong immunity because they received the MMR vaccine instead of becoming infected, as she did. Infection in some cases does result in stronger or longer protection than vaccines provide, but experts say that extra protection doesn’t outweigh the dangers of going unvaccinated.
  • Shine warned pregnant people not to get vaccines because of a lack of safety testing and approval from the Food and Drug Administration. It’s true that the FDA hasn’t licensed vaccines for use during pregnancy, but there is a large body of evidence to support the use of several vaccines. And the Centers for Disease Control and Prevention recommends that women get certain vaccines during each pregnancy.
  • She falsely said that “many” of the kids in the ongoing Washington state measles outbreak had been vaccinated, and called for the media “to confirm 75% of those infected w/ measles in NY were fully Vaccinated.” The overwhelming majority of people in both outbreaks were not vaccinated.
  • Shine retweeted articles from unreliable websites that inaccurately claim there is evidence that the measles vaccine is responsible for spreading the disease. There are no documented cases of measles passing from one person to another because of vaccination.

We don’t typically analyze statements made by the spouses of political figures. But Shine’s claims, if taken seriously, could be dangerous to public health. Here, we unpack the many falsehoods and explain how she misconstrued some otherwise interesting early-stage cancer research.

Childhood Diseases Don’t ‘Keep You Healthy’

The Feb. 13 tweet that kicked off Shine’s comments about measles and vaccines poked fun at the ongoing outbreaks and demonstrated a lack of understanding about the purpose and efficacy of vaccines. To date in 2019, there have been six measles outbreaks, including three in New York, and one each in Texas, Illinois and Washington state.

Using the baby boomers as an example, Shine suggested that contracting the measles virus wasn’t so bad, and even went so far as to say that bringing childhood diseases back might be an improvement, since they “keep you healthy & fight cancer.”

Both of these ideas, however, are false. It’s true that if you survive a childhood disease, you will develop immunity that will protect you later in life. But gaining immunity through natural infection is dangerous. And bringing childhood diseases “back” will not fight cancer.

We’ll address the cancer claim later, but first, let’s review some epidemiological history.

In the decade before the first measles vaccine became available in the United States in 1963, the measles virus infected 3 to 4 million Americans every year, mostly children. Between 1956 and 1960, more than half a million cases were reported to the CDC every year, and an average of 48,000 people were hospitalized and 450 people died.

These figures mean that thousands of baby boomers born between 1946 and 1964 died from the measles, although the youngest in the generation may have received the vaccine.

Thousands more suffered from complications, including pneumonia; encephalitis, or brain swelling, which can lead to permanent brain damage; and ear infections, which can result in hearing loss — not to mention the pain and suffering of a normal, uncomplicated case of the measles, which includes a fever, cough, runny nose, red eyes and a characteristic rash.

With vaccination, reported cases of measles in the U.S. have fallen more than 99 percent. According to one estimate by researchers with the CDC and the World Health Organization, the measles vaccine has saved more than 20 million lives across the globe this century alone.

Rates of an uncommon but fatal complication of the measles known as subacute sclerosing panencephalitis, or SSPE, also dropped as immunization became standard. In the condition, children develop fatal neurological symptoms six to eight years after contracting the measles virus.

In 2000, the United States declared the disease “eliminated,” meaning the measles virus had not been continuously spread to others for a year or more in a specific geographic area. That status remains today.

The disease is still a concern, however, because the measles is still common in other parts of the world, and can be imported. Outbreaks usually happen when someone who is unvaccinated catches the disease abroad and brings it back to the U.S., transmitting it to others who lack immunity. Measles is highly contagious, and 90 percent of people who aren’t immune will become ill if they’re exposed to a sick person coughing and sneezing.

Today’s measles vaccine, which is given in two shots as part of the combined measles, mumps and rubella, or MMR, vaccine, is highly effective. One dose of the measles vaccine provides protection against measles for 93 percent of people, and it is effective for 97 percent of people who receive two doses.

The vaccine, which is made of a live virus that has been weakened, or attenuated, is also safe. The most common adverse reaction is a fever, which affects 5 to 15 percent of people. About 5 percent of people develop a mild rash. More serious reactions include allergic reactions, but those are extremely rare, roughly one in 1 million doses.

Contrary to what Shine suggests, it’s far safer to gain immunity from the vaccine than from the natural infection. Even with the best medical care, 1 to 2 of every 1,000 measles patients will die, and a quarter of patients are hospitalized.

The measles vaccine, in contrast, has rarely been associated with any deaths in healthy people, and it has not been shown that the vaccine caused those deaths. As the World Health Organization explains on its website, “so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.”

Finally, a recent study suggests there are added benefits from measles vaccination beyond just avoiding measles infection. A 2015 study published in the journal Science found that measles vaccination was associated with less mortality from other childhood diseases. Researchers think that’s because the measles infection might tamp down a person’s immune system for as long as two to three years, making people more susceptible to other diseases during that period. This is yet more evidence that it’s childhood disease vaccination — not infection — that keeps you healthy.

Measles and Cancer

After Shine said that childhood diseases “fight cancer,” she explained herself by tweeting stories that described preliminary research from the Mayo Clinic.

https://twitter.com/DarlaShine/status/1095712318212767744

The Mayo Clinic did publish a case report in 2014 about a patient with multiple myeloma who went into remission after receiving an experimental therapy using a measles-derived virus. But Shine is wrong to conclude that the research advocates for more people to become infected with the measles.

As mentioned in both articles, the researchers were not infecting people with the naturally occurring measles virus to fight cancer. They were using a modified virus that is weakened, and similar to the measles vaccine virus. In other words, they weren’t injecting patients with the measles; they were giving them a big dose of the vaccine.

The idea was for the virus to infect the cancerous cells, and cause them to fuse together and then break apart and die, which is the measles virus’ modus operandi. But it was important that the virus not be its normal, potent self.

Angela Dispenzieri, the Mayo Clinic researcher who was in charge of that trial, told us that scientists would never consider infecting cancer patients with actual measles.

“That could be death, because it is such a bad virus,” she said in a phone interview.

Along with being safer, the vaccine version of the measles virus may be especially useful for this type of oncovirotherapy because it tends to use a particular receptor to enter cells that is more common on certain cancerous cells than on healthy cells. In that way, it may help keep the killing power limited to the tumor.

The research grew out of observations that some leukemia and lymphoma patients improved after coming down with the measles. But Dispenzieri emphasized that those findings were anecdotes. They were useful in thinking up this new approach to tackling cancer, she said, but they don’t prove, even for people with these types of cancers, that measles infection would result in a net benefit, rather than harm.

Dispenzieri also cautioned that although the therapy appears to have worked for the one patient, researchers have yet to see a similar response in others. The work is still in its earliest stages, she said, and it’s not FDA-approved.

Immunity Duration

Shine also touched on the idea that her naturally acquired immunity was longer lasting than her children’s, because they received vaccines.

The immunity a person develops after getting sick with a disease is sometimes superior to vaccine-acquired immunity.

The body, after all, is being exposed to a much larger dose of the microbe, over a longer period of time, so it’s not too surprising that this could result in stronger or longer-lived immunity. But that’s also why the person falls ill. The idea that it would be worthwhile to forgo the vaccine to get these slight improvements is a persistent vaccine myth.

As we’ve already highlighted, gaining immunity by getting the measles comes with a much higher risk of either dying or developing a serious complication than doing so by getting vaccinated.

It also puts other people at risk. Getting as many people vaccinated as possible protects people for whom vaccination hasn’t worked, along with all the people who can’t be vaccinated, such as infants and people with compromised immune systems. This is known as herd immunity.

Vaccines replicate the experience of natural infection using much smaller doses or inactive portions of viruses and bacteria, so that there is still protection, without the danger or hassle of becoming sick.

Notably, there are several pathogens for which vaccines provide better protection than natural infection, including pneumococcal bacteria, tetanus and human papillomavirus, or HPV. With tetanus, for example, it takes so little toxin to become ill that it’s not enough to trigger the body to create protective antibodies. A person needs the vaccine to develop immunity.

Vaccine Safety During Pregnancy

Shine’s third vaccine-related tweet inappropriately concluded that pregnant women should not be vaccinated.

Shine’s statement was made in response to a tweet by a naturopathic doctor, who was sharing an article from the Children’s Health Defense, an organization opposed to vaccination.

The article and tweet focus on the fact that the FDA hasn’t approved vaccines for use in pregnant women, which is true.

But Linda Eckert, an obstetrician-gynecologist and expert on maternal immunization at the University of Washington, told us that is really more of an agency technicality — and one that doesn’t change the fact that several vaccines have been well tested in pregnant women, and have demonstrated benefits for both the infant and mother.

“We have a lot of data on the safety of immunization during pregnancy,” said Eckert in a phone interview.

One of the problems, Eckert said, is that pregnant women were excluded from all clinical trials for 30 years, making the traditional studies needed for FDA approval impossible to do.

And just because the FDA hasn’t licensed a vaccine for pregnant people doesn’t mean the FDA doesn’t want women to use them. FDA scientists explain in an article published in the journal Vaccine that even though the pre-licensure studies haven’t been done, that “does not preclude use of these vaccines during pregnancy,” and that “such use is not considered to be ‘off-label,’” adding that the recommendations from various groups “are not inconsistent with FDA labeling.”

According to the CDC, pregnant women should get the seasonal influenza and whooping cough, or pertussis, vaccines during each pregnancy.

The influenza vaccine is important because influenza can make pregnant women so sick.

“The flu hits you harder when you’re pregnant,” Eckert said, “and it’s also harder on the pregnancy.”

As the CDC explains on its website, millions of pregnant women have received flu shots, and many studies support the safety of the vaccine.

The pertussis vaccine is given to mothers in the third trimester to protect babies once they are born. In this case, the vaccine triggers mothers to produce antibodies, which are passed to their babies and provide protection for the two months until the infant can get his or her own whooping cough vaccine.

The CDC’s vaccine advisory committee recommends that other vaccines be given only under certain conditions, such as when a mother is traveling abroad. Some vaccines, including live attenuated vaccines, should not be used. But that guideline is not because of any known danger, but because of a theoretical risk.

Wrong Outbreak Stats

In the afternoon, after facing pushback from people on Twitter, Shine threw in another false claim: that “many” of the children in the Washington state outbreak had been vaccinated. That was and remains inaccurate. 

Nearly all of the measles cases in the ongoing outbreak in Washington are in Clark County, which borders Oregon and includes the city of Vancouver. At the time Shine tweeted, the county public health department stated on its website that of the 53 confirmed cases, 47 were in unimmunized people, five were in people with unverified vaccination status, and one was in a person who had received a single dose of the MMR vaccine. Two doses are recommended for maximal protection.

As of Feb. 27, the department reported 65 confirmed cases, 57 of which are in unimmunized people, six are unverified, and two are in people who had received one dose of the MMR vaccine. None are in people who have received both recommended doses of the MMR vaccine.

One additional confirmed case in Washington has been reported in a 50-year-old man in King County, which includes Seattle. The county health department told us the patient reported being vaccinated as a child, but had no verifiable proof of immunization.

Nine hours after the Washington state tweet, Shine applied the same line of thinking to the outbreak in New York, retweeting someone else’s incorrect figures for Rockland County.

When Shine tweeted, Rockland County’s website reported that just 4.6 percent of the 135 confirmed cases were in people who were fully vaccinated. In contrast, 81.5 percent were in people who had not been vaccinated. Another 3.1 percent were in people who had received one MMR shot, and the vaccination status of the remaining 10.8 percent was unknown. Since then, there have been four more reported measles cases, but the vaccination percentages have stayed the same.

While vaccinated cases are rare in both of these outbreaks, it’s not uncommon to find outbreaks in which the vaccinated numbers are higher, and even outstrip the number of unvaccinated ones. These instances, however, aren’t evidence that vaccinated people are at higher risk — they’re fully expected because of basic math.

As the College of Physicians of Philadelphia explains on its vaccine website, because no vaccine is 100 percent effective, if the vaccinated group is large enough, even a small vaccine failure rate could mean there are more susceptible people in the vaccinated group than in the unvaccinated group. This is why it’s not very useful to gauge risk by looking at the absolute number of sick people who were vaccinated or unvaccinated. Instead, one needs to factor in the size of the total vaccinated or unvaccinated population, and consider the percentage of sick people in each group.

Vaccines Don’t Spread Measles

Shine also peddled the false idea that the measles vaccine spreads the disease by sharing links to two inaccurate stories posted on suspect websites.

https://twitter.com/DarlaShine/status/1095770817013665793

Both stories, which are riddled with a variety of errors, cite several legitimate studies that reported finding evidence of the vaccine strain of the measles virus in the bodily fluids of children who had been vaccinated. Some of these children had developed measles or measles-like symptoms — something we’ll touch on later. These studies used a highly sensitive method for detecting viral genome fragments called RT-PCR, which enabled them to differentiate between the naturally occurring measles virus and vaccine strains.

Contrary to what is claimed in the stories, none of these studies report that the children were contagious or were part of an outbreak. This is an important distinction, says Paul Offit, the director of the Vaccine Education Center and an infectious disease specialist at the Children’s Hospital of Philadelphia.

“The genome can be detected,” he said in a phone interview. But, he added, it’s not the measles virus. “It’s highly weakened, and it’s not spread.”

The release of viral particles, or what’s known as viral shedding, can be a problem with other live attenuated vaccines. The oral polio vaccine, for example, causes children to shed the virus in their stool and other bodily fluids, which if picked up by other people without immunity, can lead to infection. Partly for this reason, the U.S. discontinued all oral polio vaccines in 2000, and replaced them with inactivated versions that cannot do this.

But with the measles, there isn’t a single convincing case that the vaccine has ever transmitted the virus to another person. As a 2016 systematic review in the journal Vaccine concluded, “No evidence of human-to-human transmission of the measles vaccine virus has been reported amongst the thousands of clinical samples genotyped during outbreaks or endemic transmission and individual case studies worldwide.”

A case report published in the Lancet in 1989 suggested the possibility, after a UK physician described a scenario in which an 8-month-old developed measles symptoms after her 4-year-old brother was vaccinated. But that conclusion was entirely based on the timing and clinical presentation. It didn’t even include a lab test to confirm measles, which was available at the time. Since then, there have been no other reports.

Researchers are so confident that the measles vaccine is not a vehicle for transmission that the CDC recommends the vaccine even for individuals who live in households with immunocompromised people.

Finally, because the case studies touch on whether the measles vaccine might have caused the measles, the answer is, it’s possible, but exceedingly rare.

There are just a handful of isolated cases in the medical literature of children developing measles after receiving the vaccine. In most of these cases, the symptoms may not qualify as the full-blown disease, or the kids had immune deficiencies.

There are only a couple of instances in which a healthy child has developed what appears to be full-blown measles from the vaccine strain of the virus, and even those cases can’t rule out alternative causes or unique circumstances.